In a letter to Dr. Patrick Conway, the Innovation Center's acting director, the AHA said that financial risks outweighed the potential bonuses for hospitals under the Medicare shared-savings program, the accountable care initiative created under the Patient Protection and Affordable Care Act. “The No. 1 way to increase participation in ACO programs is to modify the shared-savings determination to ensure that more ACOs are able to receive a bonus—and a larger bonus—so that they can continue to invest in the program.”

The Medicare shared-savings program as of January included roughly 320 ACOs, or networks of providers that contract to reduce health spending and meet quality targets in exchange for a share of savings that exceed certain benchmarks. A limited number of ACOs also volunteered to be at risk for losses if spending exceeds the benchmarks. In exchange, they qualify for larger bonuses if they succeed. After three years, all ACOs must enter the riskier contracts.